The Canadian Association for Enterostomal Therapy (CAET) had much to celebrate this past spring: our 30th Anniversary as an independent professional nursing organization and Certification. Sharing authorship are Mary Hill, Past President (2008-2010) and National Conference Planning Coordinator, and Susan Mills-Zorzes, Past Director of CAET Enterostomal Therapy Nursing Education Program (ETNEP) and President Elect (2010-2012).
30 Years and Going Strong
This year marks CAET's 30th anniversary as a professional enterostomal therapy (ET) nursing association specializing in wound, ostomy and continence care. We are proud of our many accomplishments, which serve to achieve outcomes enhancing the lives of our clients and ET nursing specialty. Here are a few of our accomplishments over the past 5 years.
In Education...
* The CAET's ETNEP changed its name to the CAET Academy. Diversification of education programs resulted in 2 new online courses in wound care for registered nurses and RPNs (LPN) called Knowledge to Practice.
* A new Web site was created for CAET and CAET Academy (http://www.caet.ca).
* The CAET, in collaboration with Health Canada (federal government) and First Nations and Inuit Health Branch, completed an analysis of the First Nations and Inuit educational needs assessment. This resulted in the implementation of 2 education sessions in ostomy and continence (JWOCN, July/August 2011).
* The CAET and the Canadian Association for Wound Care developed a bilingual Wound Care Instrument, which provides standards for the development and evaluation of education programs in wound care (JWOCN, July/August 2011, http://www.caet.ca).
In Research...
* The CAET funded its first cost outcomes study, An Innovative Enterostomal Therapy Nurse Model of Community Wound Care Delivery: A Retrospective Cost-effectiveness Analysis (Harris and Shannon, JWOCN, 2008). This retrospective pragmatic study provided data supporting the benefits of ET/WOC nursing in the management and treatment of acute and chronic wounds. The results demonstrated that the greater involvement of ET/WOC nurses in the management of patients with wounds resulted in shorter healing times and cost savings.
* Best Practice Recommendations for enterocutaneous fistula were developed and published (http://www.caet.ca).
In Organizational Development...
* The CAET reorganized its infrastructure to include 5 new core programs: National Conference Planning, Political Action, Professional Development and Practice, Informatics and Research, and Marketing.
* A national CAET database was created.
* The CAET's logo was redesigned to include bilingual inscription.
In Leadership/Policy Development...
* Enterostomal therapy nursing was recognized by the Canadian Nurses Association (CNA) as a nursing specialty (2007).
* The first ET nurse Certification Examination was written (2008).
* An affiliation agreement was established with WOCN to add the CAET Feature Section in JWOCN.
* The CAET collaborated with the CNA to develop a resolution to create strategies to protect specialized nursing knowledge and skills that would have a negative impact on patient outcomes if replaced by lesser skilled or different skilled workers. Enterostomal therapy nursing was cited as a nursing specialty example.
CAET Annual National Conference-Montreal, Quebec, Canada
The CAET's conference was held in beautiful, old Montreal, Quebec, Canada. This year's theme, "30 years of ET Nursing, Leadership and Teambuilding," celebrated CAET's 30th Anniversary. Acknowledging our bilingual country, over 50% of the educational sessions were presented in French on a wide range of topics including leadership, innovative, and collaborative practice. The following are some of the educational highlights.
Evidence-Based Recommendations for Conservative Sharp Wound Debridement
The Conservative Sharp Wound Debridement (CSWD) evidence-based recommendations were debuted. These recommendations are a result of CAET's decision and commitment to advance clinical nursing practice to improve the provision of client care through the development of an open source guide. The recommendations were based on the CSWD available literature and through an international stakeholder review process were critically reviewed and consensus was obtained. These recommendations address CSWD in the adult population primarily with chronic wounds in acute care, clinic, and community/home care settings. Wound care specialists, organizations, and policy makers can refer to these recommendations in the development of materials on CSWD. Elise Rodd-Nielsen, Jean Brown, Helen Fatum, Jillian Brooke, Josee Morin, Mary Hill, and Liette St Cyr were on the development team. The CSWD recommendations will be posted on the CAET Web site.
International Panel on ETN and Continence Care
This presentation encouraged Canadian ET nurses to reflect on their role in continence care. In Canada, our ETNEP includes instruction in all 3 domains: wound, ostomy, and continence care. Few ET nurse graduates practice equally in all 3 domains; continence care is less practiced. However, continence management is becoming increasingly important as our population ages and women are more comfortable in voicing their continence needs. Renowned continence experts from Brazil (Vera Lucia Conceicao de Gouveia Santos), Canada (Laura Robbs), the United Kingdom (Amanda Wells), and the United States (Dorothy Doughty) moderated by Louise Forest-Lalande (President of the World Council of Enterostomal Therapists) formed a panel to discuss the diverse practices in continence from their respective countries.
Apprenticeship in Action for Wound Care With Teleassistance in Quebec
This presentation focused on the use of teleassistance with a wound care specialist to remote regions of Quebec promoting the decentralization of nursing expertise. This technology allows an ET specialist to support and guide a nurse in real time assisting in assessment and treatment options of a client in the remote clinical setting. Teleassistance allows mentorship between the expert nurse and the novice nurse supporting their clinical competencies. Helene Bouchard and Sonia Quirion were the presenters.
Workshops
Educational workshops returned this year with an expanded repertoire of topics. Clinical practice skills in enterocutaneous fistula management and debridement were presented in English and French. Leadership was showcased in presentations on developing interdisciplinary wound care teams and how to enhance skills as an ET nurse consultant. Interpreting research provided the opportunity to refine research skills and knowledge.
Certification in Canada
In 1999, the CAET had a vision-to become a recognized nursing specialty and to provide Canadian Enterostomal Therapy Nurses with the opportunity for a Canadian recognized certification credential. The CNA recognizes all nursing specialties and manages the only national nursing certification, competency-based program in Canada.
In Canada, certification is a voluntary, recognized credential for registered nurses who meet specific nursing practice criteria, continuous learning, and exam-based requirements.1 The credential, which must be renewed every 5 years, distinguishes nurses with advanced knowledge from those at the entry level to practice, and confirms that a registered nurse has demonstrated excellence and competence in a nursing specialty/area of nursing practice by having met predetermined standards. The CNA further states that the "certification credential indicates to patients, employers, the public and professional licensing bodies that you are qualified, competent and current in a nursing specialty/area of nursing practice".1
Changes in the Canadian healthcare environment fueled the CAET to pursue this 10-year-long journey:
* Consumers of healthcare are better educated about their conditions and demand to be decision-making participants in their care. They expect to be cared for by competent specialists;
* healthcare is more dynamic, more complex, and resource demanding, requiring expert, expeditious, and cost-effective management; and
* professional organizations and employers recognize certification as a commitment to the leading edge in healthcare standards.1
Research suggests that certification contributes to improved patient care outcomes and certified nurses are more confident of their ability to recognize signs and symptoms of complications and intervene appropriately. This implies that the market value of the ET nurse would be enhanced as nurses specialized in the 3 domains of wound, ostomy and continence care also possess the knowledge, skills, and judgment that demonstrate competence within these domains.
In 2007, Enterostomal Therapy Nursing became the 18th nursing specialty to receive this distinction in Canada. The process for specialty designation began in 2000 with the submission of a proposal that had to meet 7 criteria:
1. That ET nursing had established standards of practice;
2. a role description;
3. a specific population of patients;
4. a written description of key problems and situations addressed by ETN practitioners;
5. supporting nursing literature, education, and research;
6. a description of the number of nurses in the specialty across the country; and
7. the human resources to support the certification process.
A tremendous number of volunteer hours, hard work, negotiation, and renegotiation on the part of Canadian ETs were invested to prepare the CAET proposal, develop our ET nurse competencies to meet CNA standards, redevelop our national ETNEP based on these competences, negotiate eligibility criteria, and develop validated test questions. The testing method is a multiple-choice examination of approximately 170 questions in all 3 domains of ET nursing. One potential barrier perceived by the CNA was CAET's relatively small size (approximately 250 active ET members at the time) and hence, the ability to support the over $100,000.00 examination development investment. However, Canadian ET nurses would not be discouraged and in 2008 to the surprise of the CNA 60 ET nurses applied to write the first ET nursing certification examination in 2009. This marked a significant moment in the history of CAET!
At the time of this writing, the third ET nurse certification examination has been written and we are proud to announce that CAET has 95 certified ET nurses, which represents 29.6% of our total active ETN membership. These ET nurses can rightfully sign CETN(C) after their name (Certified Enterostomal Therapy Nurse, Canadian). The CAET looks forward to 2012 when we hope to recognize the 100 CETN(C) mark and celebrate nationwide our nursing specialty.
References